Aim: This study aimed to assess the acceptability, suitability and training impact of a virtual reality (VR)-based stress-management training tool for mental health nurses in Australia. Background: VR is increasingly being considered a platform suitable for providing training to healthcare professionals. Barriers for adoption include both practical challenges inherent to the technology as well as end-user perceptions. Design: We undertook a pilot feasibility study within a large public training hospital in Australia, to assess the acceptability, suitability, and training impact of the VR-based stress-management training platform, Performance Edge (PE). The program was integrated into a pre-existing one-day emotional awareness and regulation workshop at the Gold Coast Hospital and Health Service (Queensland, Australia) in September 2023. Methods: Observational and self-report data were collected during implementation of the workshop, which integrated five VR-delivered stress-management lessons. Study participants were workshop attendees (mental health nurses) and educators involved in workshop delivery. Results: All participants completed the workshop without encountering technical issues or adverse events. Both educators and attendees provided consistently positive feedback on PE’s usability, suitability, and relevance for healthcare settings. Participants reported increased knowledge, understanding and confidence in stress-management skills immediately and at follow-up, three to six weeks after the workshop. Moreover, clinicians reported actively using stress-management skills more after the training. Conclusions: The VR platform offered practical stress-management skills training, which was perceived to be relevant and suitable among nursing professionals. The use of VR technology in general was also perceived as particularly valuable for this training context, providing a safe and immersive environment. By demonstrating acceptability across a range of metrics, this study supports the feasibility of using VR-delivered stress-management interventions within a clinical workforce. This feasibility trial is an important stepping stone for the broader implementation of VR within healthcare education.

Insomnia is a highly prevalent and debilitating condition, yet access to treatments remains limited and expensive. Mindfulness-based interventions (MBIs) offer a promising alternative, but traditional delivery methods often fail to engage participants effectively. Building on the potential of MBIs, virtual reality (VR) offers immersive and customizable experiences that may enhance engagement and therapeutic impact. VR can reduce cognitive arousal—a core mechanism of insomnia—and facilitate mindfulness training. However, the feasibility of at-home VR mindfulness for insomnia remains underexplored. To address this gap, this study aimed to evaluate the feasibility of a 4-week at-home VR-delivered mindfulness intervention (VRmind) as a treatment for insomnia. To investigate this, we conducted a two-arm, parallel-group randomized controlled feasibility trial (ANZCTRN12623000892617) with 60 adults (mean age = 45.1 ± 14.9 years) experiencing insomnia. Participants were randomized (2:1) to either at-home VR mindfulness (VRmind, n=40) using an Oculus Quest 2 headset or to an active comparator condition (Control, n=20) watching relaxing imagery and music using a smart device. The intervention was delivered twice weekly over 4 consecutive weeks; each session was approximately 20 minutes. Primary outcomes included feasibility indicators: treatment engagement, adherence (≥6 sessions completed), and acceptability (Multi-Dimensional Treatment Satisfaction Measure, MDTSM > 2). Secondary outcomes included changes in insomnia severity (ISI), sleep quality (PSQI), mood and anxiety (DASS-21), rumination (RRS), negative thoughts (ATQ-N), stress-related insomnia (FIRST), and mindfulness awareness (MAAS). Outcome measures were collected at baseline, weeks 2, 4, and 8. VR mindfulness was found to be feasible, with high treatment engagement, adherence, and completion. The target treatment completion rate was exceeded, 83% (33/40) of VRmind participants completed treatment compared to 50% (10/20) in Control condition. The mean session completion for the VRmind condition was 7.6 (SD 2.78) compared to 4.5 (SD3.35) in the Control. At-home VR mindfulness was considered a more acceptable treatment for insomnia than the relaxing music video-based Control condition. VR delivered mindfulness was rated as an acceptable intervention (mean MDTSM > 2) by 74% of participants, compared to 55% of Controls. At-home VR mindfulness is a safe intervention, no serious adverse events were reported, 36% reported minor discomforts (e.g., headset fit issues, transient dizziness). Beyond feasibility and safety, VRmind participants demonstrated a greater reduction in insomnia severity (mean –7.1 ISI points) compared to controls (mean –4.1 points). VR-delivered mindfulness was shown to be feasible, acceptable, and engaging for people with insomnia, with promising adherence rates and preliminary efficacy. Taken together, these findings support the scalability and clinical potential of VR mindfulness as a novel approach to insomnia care. Further investigation in larger-scale trials using objective sleep measures is warranted to confirm long-term benefits. ANZCTRN12623000892617

Total knee arthroplasty (TKA) is an effective treatment for end stage osteoarthritis. However, biopsychosocial features are not routinely considered in TKA clinical decision-making, despite increasing evidence to support their role in patient recovery. We have developed a more holistic model of patient care by using machine learning and Bayesian inference methods to build patient-centred predictive models, enhanced by a comprehensive battery of biopsychosocial features. Data from 863 patients with TKA (mean age 68 years (SD 8), 50% women), identified between 2019 and 2022 from four hospitals in NSW, Australia, was included in model development. Predictive models for improvement in patient quality-of-life and knee symptomology at three months post-TKA were developed, as measured by a change in the Short Form-12 Physical Composite Score (PCS) or Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), respectively. Retained predictive variables in the quality-of-life model included pre-surgery PCS, knee symptomology, nutrition, alcohol consumption, employment, committed action, pain improvement expectation, pain in other places, and hand grip strength. Retained variables for the knee symptomology model were comparable, but also included pre-surgery WOMAC, pain catastrophizing, and exhaustion. Bayesian machine learning methods generated predictive distributions, enabling outcomes and uncertainty to be determined on an individual basis to further inform decision-making.

BACKGROUND:Dissatisfaction with Total Knee Arthroplasty (TKA) surgical outcomes remains between 10-20% and is associated with higher levels of societal costs. Expectations regarding post-surgical outcomes is considered as one of the major factors influencing satisfaction, however, there are no standardised methods for assessing patient's expectations regarding activities to be achieved following surgery. OBJECTIVES:The aims of this study were to identify patient expectations relating to activities of importance following TKA and to describe goal fulfillment at 3 months post-TKA. We hypothesised that activity expectation fulfillment would be associated with overall satisfaction with TKA outcomes. METHODS:This study comprised secondary data analysis of findings from the SuPeR Knee study. Using conventional content analysis, a classification system of activities specific to our TKA patient cohort was created. At 3 months following TKA, patients rated satisfaction with fulfilling activity goals and pain attenuation. The average level of satisfaction achieved was used as our measure of goal fulfillment. Overall satisfaction of the outcomes of surgery was rated using a 5-point Likert scale and the association between goal fulfillment and overall surgery satisfaction was compared by Spearman's rank correlation. RESULTS:Data were collected from 861 TKA patients. Recreation and sporting pursuits were found to be important activity types (43% of all activities). At 3 months after surgery, less impactful activities were more commonly satisfied (67%), including domestic and vocational activities, low impact hobbies and leisure activities. Goal fulfillment and improvement in knee pain were both significantly positively correlated to, and significant predictors of, overall patient satisfaction (p≤0.001). CONCLUSIONS:Our Australian cohort of TKA patients have a range of expectations for undertaking high-impact activities after surgery. However, at 3 months after surgery, higher rates of satisfaction were attained for lower-impact activities. Our findings support the importance of identifying activity expectations for each patient and that fulfillment of these goals contributes to overall satisfaction with the outcomes of TKA.

Abstract Background Variation in stroke treatment metrics highlight a need for approaches to improve clinical processes. Training interventions can improve outcomes, but Australian physician trainees do not currently receive formal process-directed stroke training. Virtual reality (VR) stroke workflow training has proven acceptable, usable, useful and feasible in trial contexts, but how to integrate VR training into physician training remains unclear. The current study sought to document stroke staff perceptions of existing training and assess implementation of routine VR training at comprehensive stroke centres, outside of a trial context. Methods Training was delivered to physician trainees via individual sessions or facilitated group workshops depending on the hospital site. VR usage data was captured automatically via Wi-Fi. Survey responses from both trainees and training staff were collected, with statistical comparisons performed for matching questions in pre- and post-training surveys. Themes identified in open-ended survey responses were enumerated and reported. Results Forty-two TACTICS VR training sessions were logged at 2 hospitals between May 2022 and October 2023. Trainees reported receiving low amounts of prior formal stroke training; both trainees and training staff identified unmet needs and barriers to existing training. VR users (n = 30) provided positive feedback on VR hardware, software design, user experience, content, educational value and delivery approach (mean scores 3.9 to 4.7; 1 = strongly disagree, 5 = strongly agree). VR training improved confidence in: knowledge of acute stroke assessment / treatment (post-training vs. pre-training = 4.0±0.7 vs. 2.9±1.0; P < .0001), ability to effectively assess / treat stroke (4.0±0.6 vs. 3.1±1.0; P < .0001), ability to optimally communicate with colleagues (4.1±0.6 vs. 3.3±1.0; P < .001), understanding of workflow practices (4.3±0.6 vs. 3.2±1.2; P < .0001), ability to make improvements (4.1±0.8 vs. 3.0±1.2; P < .0001) and awareness of local stroke management criteria / processes (4.1±0.8 vs. 3.6±1.1; P < .01). Respondents suggested enhancements in funding, access, awareness, training populations and delivery modality to improve training sustainment. Conclusions VR stroke workflow training was perceived by trainees and training staff as feasible, acceptable, usable, useful and positively impacted stroke training. Respondents endorsed future use of VR training to support training at comprehensive stroke centres and identified aspects for improved future integration.

INTRODUCTION:Globally, there is an increasing demand for quality medical rehabilitation services. This is the first article of a two-part series showing the findings from the Rehabilitation Choices study in which the main aim was to understand the current landscape of decision-making, enablers and barriers to access appropriate rehabilitation services in the Australian setting. In Part 1, these insights were sought from a healthcare professionals' perspective. METHODS:This was an exploratory, qualitative study, using semi-structured interviews with a discussion guide that was codesigned together with rehabilitation clinicians and rehabilitation researchers. Themes and sub-themes were identified using an inductive approach. RESULTS:We interviewed a heterogeneous group of 31 professionals who are involved in making referral decisions about rehabilitation or who design and deliver rehabilitation programs, including specialist rehabilitation physicians and other medical doctors across in-patient, outpatient, and primary care settings, allied health professionals, rehabilitation service managers, nurses, multicultural health liaison officers and rehabilitation research scientists. Three key themes relevant to barriers and enablers to service access were identified from the data: defining rehabilitation; a lack of timely access to patient and rehabilitation service data; and patient diversity not expected by the system. CONCLUSIONS:Healthcare professionals who make decisions about rehabilitation referrals and services feel that it was necessary for them to keep up to date with information relating to rehabilitation services. There was some concern regarding what rehabilitation constituted and what services were available for different clinical indications. They also indicated that current systems did not consider diversity among patients' needs and goals. Their recommendations included the need for better communication pathways, improved referral systems and resources that could help provide best practice of rehabilitative care in the future. PATIENT OR PUBLIC CONTRIBUTION:Three study team members had a lived experience of rehabilitation as a patient or carer, and previous experience participating in qualitative research. They worked with the study team to codesign the recruitment strategy, participant-facing communications, the interview discussion guide, and the approach to the conduct of activities with participants and in the interpretation and contextualization of findings and all were involved in writing this manuscript.

Background:Telestroke networks aim to address variability in both quality and access to stroke care in rural areas, by providing remote access to expert stroke neurologists. Implementation of telestroke requires adaptation of workflow processes and education. We previously developed virtual reality (VR) workflow training and documented acceptability, utility and feasibility. The effects on acute stroke treatment metrics have not been previously described. Aims:The overall aim was to improve hyperacute stroke metrics and shorten the time-to-reperfusion therapy administration in rural settings. Methods:This study applies a natural experiment approach, collecting stroke metric data during transition from a pre-existing pilot to a statewide telestroke service at five rural hospitals. Pre- and post-intervention data included baseline patient demographics and assessment, diagnosis, and treatment delivery metrics. The primary study outcome was door-to-decision time (thrombolysis and endovascular thrombectomy). Secondary outcomes included door-to-computerized tomography time, door-to-thrombolysis time and proportion of patients receiving thrombolysis or thrombectomy treatment. Usage data relating to the VR stroke workflow training of interprofessional healthcare professionals was automatically captured via Wi-Fi. Statistical comparisons of clinical metrics between the pre- and post-intervention time periods, defined as the timeframes before and after VR deployment, were performed. Results:A total of 2,683 patients were included (April 2013-December 2022); 1910 pre- and 773 post-intervention. All acute stroke time metrics significantly improved post-intervention. The primary outcome, door-to-decision time, decreased from 80 min [56-118] to 54 min [40-76; P < 0.001]. Secondary outcomes also improved, including door-to-thrombolysis time (90 min [68-114] vs. 68.5 min [54-90]; P < 0.001) and proportion of patients thrombolysed (11 vs. 16%; P < 0.001). The proportion of patients transferred for thrombectomy was unchanged (6 vs. 7%; P = 0.69). Seventy VR sessions totaling 15 h 39 min of training time were logged. VR training usage varied across sites (3-31 sessions per site). Conclusions:Delivery of a multi-factorial intervention including infrastructure, funding, education and training (with VR workflow training) as part of a state-wide telestroke rollout was associated with improved acute stroke treatment metrics. Additional work is required to identify the contribution of each intervention component on clinical outcomes and to increase training uptake and sustainment.

AbstractBackgroundIt has long been assumed that post‐stroke intracranial pressure (ICP) elevation occurs because of large infarct and edema volumes. However, we have repeatedly shown ICP elevation at 24 h post‐stroke in the presence of little to no edema in rats. Biological processes are often conserved across species and types of injury. Therefore, we aimed to determine if an ICP rise occurs at 24 h post‐stroke in the presence of small infarct and edema volumes in mice.MethodsMice were randomized by random number table to either photothrombotic stroke or sham surgery (n = 15). Epidural ICP was recorded using a fiber optic catheter at 1 h post‐stroke (baseline) and between 23 and 24 h post‐stroke.ResultsICP was significantly higher at 24 h compared to baseline in stroke animals (n = 6; 10.71 ± 6.45 mmHg vs. 3.74 ± 2.20 mmHg, respectively; p = 0.03). ICP at 24 h was also significantly higher in stroke mice compared to sham (n = 6; 3.45 ± 1.43 mmHg; p = 0.02). There was no change in ICP in sham mice (p = 0.9). Edema volumes in stroke animals were small (0.04 ± 0.04 mm3) and unlikely to have caused significant ICP elevation.ConclusionThis study provides evidence of an edema‐independent ICP elevation following small ischemic stroke in mice. The occurrence of this rise supports our findings in other species and suggests it is caused by a previously undescribed mechanism.

ABSTRACTIntroductionImproved access to rehabilitation is highlighted as a key pathway to achieving the World Health Organisation's (WHO) goal of ensuring healthy lives and promoting well‐being for all (Sustainable Development Goal 3). This article is the second in a two‐part series outlining the findings from the Rehabilitation Choices study, which aimed to identify how health professionals and consumers in Australia are informed to make decisions about rehabilitation, and their experience with barriers and enablers to accessing that rehabilitation. In this study, we present the perspectives of consumers with different health conditions and a range of experiences with rehabilitation services.MethodsThis was a qualitative study using focus groups and semi‐structured interviews. People with self‐reported lived experience of rehabilitation and carers were recruited using maximum variation sampling. Thematic analysis of data was conducted using an inductive approach.ResultsFifty‐six consumers with diverse lived experiences of rehabilitation (19–80 years, 49 patients, 7 carers) participated in focus groups and interviews to discuss how they sourced information about rehabilitation and their experiences of what made it hard or easy to access rehabilitative care to meet their needs. Four themes were produced from the data: (1) service‐centricity of options limits access, (2) access is the patient's responsibility, (3) enabling decision‐making about rehabilitation with appropriate information and (4) provision of a psychologically safe environment.ConclusionsAny planned (re)design of services to improve consumer access to rehabilitation should consider the themes identified in this study. This will ensure that consumers are provided with rehabilitation options that suit their holistic and unique needs beyond consideration of their medical diagnoses, and are actively supported to navigate this access, provided with information to help them make informed choices and provided a psychologically safe environment to engage effectively with rehabilitation.Patient or Public ContributionThree consumer research partners with lived experience of rehabilitation as patients or carers were core team members. They were involved in the design and implementation of the recruitment and communications strategies, design of the interview approach and discussion guide, contributed to the interpretation and contextualisation of findings and writing of this manuscript and are included as co‐authors (A. O., T. W. and S. W.).

Psychological stress-related injuries within first-responder organizations have created a need for the implementation of effective stress management training. Most stress management training solutions have limitations associated with scaled adoption within the workforce. For instance, those that are effective in civilian populations often do not align with the human performance culture embedded within first-responder organizations. Programs involving expert-led instructions that are high in quality are often expensive. This study sought to evaluate a tailored stress management training platform within the existing training schedule of the Australian Defense Force (ADF). The platform, known as Performance Edge (PE), is a novel virtual reality (VR) and biofeedback-enabled stress management skills training platform. Focusing on practical training of well-established skills and strategies, the platform was designed to take advantage of VR technology to generate an immersive and private training environment. This study aimed to assess the feasibility of delivering the VR platform within the existing group-based training context and intended training population. In this setting, the study further aimed to collect data on critical predictors of user acceptance and technology adoption in education, including perceived usability, usefulness, and engagement, while also assessing training impacts. This study used a mixed methods, multisite approach to collect observational, self-reported, and biometric data from both training staff and trainers within a real-world “on-base” training context in the ADF. Validated scales include the Presence Questionnaire and User Engagement Scale for perceived usefulness, usability, and engagement, as well as the State Mindfulness Scale and Relaxation Inventory, to gain insights into immediate training impacts for specific training modules. Additional surveys were specifically developed to assess implementation feedback, intention to use skills, and perceived training impact and value. PE training was delivered to 189 ADF trainees over 372 training sessions. The platform was easy to use at an individual level and was feasible to deliver in a classroom setting. Trainee feedback consistently showed high levels of engagement and a sense of presence with the training content and environment. PE is overall perceived as an effective and useful training tool. Self-report and objective indices confirmed knowledge improvement, increased skill confidence, and increased competency after training. Specific training elements resulted in increased state mindfulness, increased physical relaxation, and reduced breathing rate. The ability to practice cognitive strategies in a diverse, private, and immersive training environment while in a group setting was highlighted as particularly valuable. This study found the VR-based platform (PE) to be a feasible stress management training solution for group-based training delivery in a defense population. Furthermore, the intended end users, both trainers and trainees, perceive the platform to be usable, useful, engaging, and effective for training, suggesting end-user acceptance and potential for technology adoption.

BackgroundRecent data indicates that cerebrospinal fluid (CSF) dynamics are disturbed after stroke. Our lab has previously shown that intracranial pressure rises dramatically 24 h after experimental stroke and that this reduces blood flow to ischaemic tissue. CSF outflow resistance is increased at this time point. We hypothesised that reduced transit of CSF through brain parenchyma and reduced outflow of CSF via the cribriform plate at 24 h after stroke may contribute to the previously identified post-stroke intracranial pressure elevation.MethodsUsing a photothrombotic permanent occlusion model of stroke in C57BL/6 adult male mice, we examined the movement of an intracisternally infused 0.5% Texas Red dextran throughout the brain and measured tracer efflux into the nasal mucosa via the cribriform plate at 24 h or two weeks after stroke. Brain tissue and nasal mucosa were collected ex vivo and imaged using fluorescent microscopy to determine the change in CSF tracer intensity in these tissues.ResultsAt 24 h after stroke, we found that CSF tracer load was significantly reduced in brain tissue from stroke animals in both the ipsilateral and contralateral hemispheres when compared to sham. CSF tracer load was also reduced in the lateral region of the ipsilateral hemisphere when compared to the contralateral hemisphere in stroke brains. In addition, we identified an 81% reduction in CSF tracer load in the nasal mucosa in stroke animals compared to sham. These alterations to the movement of CSF-borne tracer were not present at two weeks after stroke.ConclusionsOur data indicates that influx of CSF into the brain tissue and efflux via the cribriform plate are reduced 24 h after stroke. This may contribute to reported increases in intracranial pressure at 24 h after stroke and thus worsen stroke outcomes.

Introduction Retaining nurses in the workforce is an urgent concern in healthcare. Emergency nurses report high levels of stress and burnout, however, there is no gold standard of how to measure these responses. This study aims to measure stress, burnout, and fatigue in emergency nurses using biomarkers and psychometric instruments. Biomarkers will be used to better understand nurses' levels of stress and burnout and to assess the feasibility of using biomarkers as a viable stress measurement tool in a real-world setting.Methods and analysis A two stage cross-sectional design to measure stress, burnout and fatigue in emergency nurses while they work is proposed. All registered and enrolled nurses working in the emergency department from four hospitals in Australia will be invited to participate. Validated psychometric tools will be used in stage 1 to measure depression, anxiety, acute stress, chronic stress, burnout and fatigue. Biomarkers comprising hair cortisol, saliva alpha amylase and heart rate variability will be collected as an objective measure of stress and burnout in stage 2 over one working shift per participant. Written consent will be sought for stage 2 where nurses will provide one hair sample, wear a heart rate sensor and be asked to collect their saliva at three different time points of one shift. Data analysis will measure the domains of acute stress, chronic stress and burnout and explore relationships and correlation between psychometric measures and biomarkers.Ethics and dissemination Ethics approval obtained from the Human Research Ethics Committee of the Hunter New England Local Health District (approval number: HREC/2020/ETH01684) and University of Newcastle HREC (H-2022-0169). Results will be reported in peer-reviewed publications using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Public dissemination will occur by presenting at conferences and to the participating local health district.

Metabolic inactivation of progesterone within uterine myocytes by 20α-hydroxysteroid dehydrogenase (20α-HSD) has been postulated as a mechanism contributing to functional progesterone withdrawal at term. In humans, 20α-HSD is encoded by the gene AKR1C1 . Myometrial AKR1C1 mRNA abundance has been reported to increase significantly during labor at term. In spontaneous preterm labor, however, we previously found no increase in AKR1C1 mRNA level in the myometrium except for preterm labor associated with clinical chorioamnionitis. This suggests that increased 20α-HSD activity is a mechanism through which inflammation drives progesterone withdrawal in preterm labor. In this study, we have determined the effects of various treatments of therapeutic relevance on AKR1C1 expression in pregnant human myometrium in an ex vivo culture system. AKR1C1 expression increased spontaneously during 48 h culture ( p < 0.0001), consistent with the myometrium transitioning to a labor-like phenotype ex vivo , as reported previously. Serum supplementation, prostaglandin F 2α , phorbol myristate acetate, and mechanical stretch had no effect on the culture-induced increase, whereas progesterone ( p = 0.0058) and cAMP ( p = 0.0202) further upregulated AKR1C1 expression. In contrast, culture-induced upregulation of AKR1C1 expression was dose-dependently repressed by three histone/protein deacetylase inhibitors: trichostatin A at 5 ( p = 0.0172) and 25 µM ( p = 0.0115); suberoylanilide hydroxamic acid at 0.5 ( p = 0.0070), 1 ( p = 0.0045), 2.5 ( p = 0.0181), 5 ( p = 0.0066) and 25 µM ( p = 0.0014); and suberoyl bis-hydroxamic acid at 5 ( p = 0.0480) and 25 µM ( p = 0.0238). We propose the inhibition of histone/protein deacetylation helps to maintain the anti-inflammatory, pro-quiescence signaling of progesterone in pregnant human myometrium by blocking its metabolic inactivation. Histone deacetylase inhibitors may represent a class of agents that preserve or restore the progesterone sensitivity of the pregnant uterus.

We have previously demonstrated that a cortical stroke causes persistent impairment of hippocampal-dependent cognitive tasks concomitant with secondary neurodegenerative processes such as amyloid-β accumulation in the hippocampus, a region remote from the primary infarct. Interestingly, there is emerging evidence suggesting that deposition of amyloid-β around cerebral vessels may lead to cerebrovascular structural changes, neurovascular dysfunction, and disruption of blood-brain barrier integrity. However, there is limited knowledge about the temporal changes of hippocampal cerebrovasculature after cortical stroke. In the current study, we aimed to characterise the spatiotemporal cerebrovascular changes after cortical stroke. This was done using the photothrombotic stroke model targeting the motor and somatosensory cortices of mice. Cerebrovascular morphology as well as the colocalization of amyloid-β with vasculature and blood-brain-barrier integrity were assessed in the cortex and hippocampal regions at 7, 28 and 84 days post-stroke. Our findings showed transient cerebrovascular remodelling in the peri-infarct area up to 28 days post-stroke. Importantly, the cerebrovascular changes were extended beyond the peri-infarct region to the ipsilateral hippocampus and were sustained out to 84 days post-stroke. When investigating vessel diameter, we showed a decrease at 84 days in the peri-infarct and CA1 regions that was exacerbated in vessels with amyloid-β deposition. Lastly, we showed sustained vascular leakage in the peri-infarct and ipsilateral hippocampus, indicative of a compromised blood-brain-barrier. Our findings indicate that hippocampal vasculature may represent an important therapeutic target to mitigate the progression of post-stroke cognitive impairment.

BACKGROUND:Medical students are at higher risk of burnout than the general population. Interventions that facilitate adaptive coping behaviors (eg, Psychological Flexibility) in the context of inherent stressors associated with medical training could mitigate burnout risk and improve well-being. Delivering these interventions using smartphone apps offers advantages such as accessibility, scalability, mitigation of time and stigma barriers, and facilitation of individual tailoring (individualization). There is a need for feasibility trials with medical students in this emerging field. Formal evaluations of user experiences of app-based psychological skill training are required to identify barriers to and facilitators of engagement and optimize intervention development before implementation in efficacy trials and real-world settings.OBJECTIVE:This study aimed to assess the feasibility of delivering an individualized Psychological Flexibility skill training intervention (Acceptance and Commitment Training [ACTraining]) to medical students using an app-based delivery format. We further aimed to explore how formal evaluation of user experiences might inform and guide the development of this app before implementation in an efficacy trial and future research involving app-delivered psychological skill training for medical students.METHODS:This single-arm study was an early-phase feasibility trial of a stand-alone ACTraining app conducted with a sample of Australian medical students (n=11). We collected app usability and user experience data across a broad range of domains (eg, perceived helpfulness and relevance, learning experiences, and self-efficacy) using self-report questionnaires (quantitative and qualitative) and behavioral engagement outcomes.RESULTS:Behavioral engagement data demonstrated that the app delivered the assessment procedures and individualized ACTraining intervention to medical students as intended. The subjective feedback provided by students who actively engaged with the app was generally positive across several indicators, including usability, perceived relevance and helpfulness, accessibility, maintenance of privacy, and opportunity for self-reflection. Disengagement from the app was an identified challenge throughout the trial. Participant feedback identified several factors that may have affected engagement, such as time, expectations regarding app interface functioning, and individual differences in confidence and self-efficacy when implementing skills.CONCLUSIONS:This study reports user experience data that have been largely absent from the literature on digital psychological interventions for medical students. Our findings demonstrate the preliminary feasibility of an app-delivered ACTraining intervention for medical student well-being and burnout and support the value of future assessment of the efficacy of this approach with larger samples. We consider subjective feedback from medical students in relation to observed engagement and propose how this information might be used to inform the development of this app and future research in this nascent field.

Drawing on the emerging area of workplace sustainability, this study sought to measure the effects of multimodal physical and cognitive fitness training on sustaining mental health and job readiness via impacts on subjective burnout, mental wellbeing, and resilience in a military cohort. Volunteer participants were block randomised into either a standard 4-week resilient mind program (RMP) intervention or an RMP combined with self-paced functional imagery practice (RMP+FI). Self-reported burnout, mental wellbeing, and resilience were measured at baseline and at the end of the 4-week intervention using the Maslach Burnout Inventory-General Survey (MBI-GS), Brief Resilience Scale (BRS), and the World Health Organization’s WHO-5 Well-Being Index (WHO-5), respectively. A total of 78 participants were enrolled in the study and 72 (92%) completed the program. Repeated measures ANOVAs showed significant effects of the RMP intervention, with both the RMP and RMP+FI groups reporting improved resilience (F(1, 70) = 13.08, p < 0.001, partial ω2 = 0.00086) and mental wellbeing (F(1, 70) = 41.86, p < 0.001, partial ω2 = 0.36). Both groups also reported improved burnout markers for professional efficacy (F(1, 70) = 6.25, p < 0.002, partial ω2 = 0.02), as well as reduced emotional exhaustion (F(1, 70) = 31.84, p < 0.001, partial ω2 = 0.02) and job cynicism (F(1, 70) = 8.80, p < 0.005, partial ω2 = 0.005). The FI practice produced no significant improvement in the RMP-only condition. Our results support the efficacy of RMP intervention in reducing burnout symptoms and improving self-reported mental wellbeing and resilience in a cohort of serving Navy aviators.

Background Stroke can be a life-changing event, with survivors frequently experiencing some level of disability, reduced independence, and an abrupt lifestyle change. Not surprisingly, many stroke survivors report elevated levels of stress during the recovery process, which has been associated with worse outcomes. Purpose Given the multiple roles of stress in the etiology of stroke recovery outcomes, we aimed to scope the existing literature on stress management interventions that have been trialed in stroke survivors. Methods We performed a database search for intervention studies conducted in stroke survivors which reported the effects on stress, resilience, or coping outcome. Medline (OVID), Embase (OVID), CINAHL (EBSCO), Cochrane Library, and PsycInfo (OVID) were searched from database inception until March 11, 2019, and updated on September 1, 2020. Results Twenty-four studies met the inclusion criteria. There was significant variation in the range of trialed interventions, as well as the outcome measures used to assess stress. Overall, just over half (13/24) of the included studies reported a benefit in terms of stress reduction. Acceptability and feasibility were considered in 71% (17/24) and costs were considered in 17% (4/24) of studies. The management of stress was rarely linked to the prevention of symptoms of stress-related disorders. The overall evidence base of included studies is weak. However, an increase in the number of studies over time suggests a growing interest in this subject. Conclusions Further research is required to identify optimum stress management interventions in stroke survivors, including whether the management of stress can ameliorate the negative impacts of stress on health.